Efficacy and safety of phacoemulsification with intraocular lens implantation under topical anesthesia

Background: To eliminate complications of peribulbar and retrobulbar anesthesia and to achieve efficacy and safety for topical anesthesia with cataract surgery. Methods: We performed clear corneal phacoemulsification with foldable intraocular lens (IOL) implantation under topical anesthesia using preservative-free 2% lidocaine drops, without intracameral anesthetic supplementation. The exclusion criteria were anxiety, small pupil, baseline endothelial count 1500 cells/mm², uncontrolled glaucoma, other ocular entities affecting corneal endothelium, and allergy to the relevant medications. We used a specular microscope to evaluate the effect on the endothelium and employed a 10-point visual analog pain scale to assess the discomfort experienced during the operation. Results: Totally, 29 eyes of 29 patients were enrolled in this series. The mean age was 71.5 ± 8.5 years. Twenty-three of 29 (79.3%) cases achieved a best-corrected visual acuity (BCVA) equal to 20/40 or better at an interval of 3 months post-operatively. Most patients (86.5%) felt mild or no pain during surgery. Pre- and postoperative endothelial counts were 2072.6 ± 104 and 1927.4 ± 196 cell/mm ², respectively. One in 29 cases developed vitreous loss due to involuntary eye movements intraoperatively. Conclusions: Topical anesthesia with preservative-free 2% lidocaine drops is an effective and safe modality for clear corneal phacoemulsification with IOL implantation. On the other hand, for patients with small pupil or those who are anxious, the procedure may be time-consuming, and it is challenging for physicians to perform cataract surgery merely using topical anesthesia.